Hepatic artery infusion chemotherapy for advanced hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Surgery, percutaneous ablation and liver transplantation are the only curative treatment modalities for HCC. However, the majority of patients have unresectable disease at diagnosis. Therefore, effective treatment options for patients with advanced HCC are required. In advanced HCC, according to current international guidelines, sorafenib, a molecular targeted agent, is the standard treatment. However, alternative treatment modalities are required because of the low response rates and unsuitability of molecular agents in real practice. In various treatment modalities, mostly in Asia, hepatic arterial infusion chemotherapy (HAIC) has been applied to advanced HCC with a view to increasing the therapeutic efficacy. HAIC provides direct drug delivery into the tumor feeding vessels and also minimizes systemic toxicities through a greater first-pass effect in the liver. However, the sample sizes of studies on HAIC have been small and large randomized trials are still lacking. In this article, we describe the treatment efficacy of HAIC for advanced stage HCC and discuss future therapeutic possibilities.

Keywords: Advanced stage hepatocellular carcinoma; Hepatic arterial infusion chemotherapy; Hepatocellular carcinoma; Sorafenib; Treatment efficacy.

Figures

Figure 1

Technical aspects of hepatic artery infusion chemotherapy. A: Liver dynamic computed tomography showing multinodular hepatocellular carcinoma (HCC) with portal vein thrombosis; B: The embolization of non-target vessels to minimize the flow of chemotherapeutic agents into both uninvolved liver parenchyma and extrahepatic tissues; C: After finding HCC in the feeding artery, the tip of the catheter was located at the proper hepatic or common hepatic artery, chemotherapeutic agents were infused through a pump; D: The proximal end of the catheter was connected to the injection port, which was implanted in a subcutaneous pocket in the right iliac fossa.

Figure 2

Favorable outcome of patient with infiltrative hepatocellular carcinoma treated by hepatic artery infusion chemotherapy. A: Patient with infiltrative type hepatocellular carcinoma (HCC) with portal vein thrombosis in liver dynamic magnetic resonance imaging (MRI) showed high FDG uptake; B: After hepatic artery infusion chemotherapy, this patient showed no viable HCC except focal portal vein thrombosis in a follow-up liver MRI and positron emission tomography/computed tomography.

Figure 3

Favorable response of patient with multinodular hepatocellular carcinoma treated by hepatic artery infusion chemotherapy. A: Patient with multinodular type hepatocellular carcinoma (HCC) with portal vein thrombosis in baseline liver dynamic computed tomography (CT); B: After hepatic artery infusion chemotherapy, this patient showed partial necrosis of HCC in a follow-up liver dynamic CT.